Critical Access Hospitals: A Special Reason to Give Thanks

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EDITOR’S NOTE: Dr. John Zelem, a featured panelist on Talk Ten Tuesdays, is a physician advisor at Adams Memorial Hospital.  He is also the founder of Streamline Consulting Solutions.

Adams Memorial Hospital is a critical access hospital (CAH) and has the Medicare designation. This designation is given to eligible rural hospitals in America. As of July 7, 2022, there are 1,360 critical access hospitals located throughout the United States.

Critical access hospitals, however, should not  be confused with the short-term acute care hospital of which there are just over 6,000.

There are a couple of major factors that establish the difference between the two types of facilities. Critical access hospitals must…

  • Be located in a rural area or an area that is treated as rural;
  • Be located either more than 35-miles from the nearest hospital or CAH or more than 15 miles in areas with mountainous terrain or only secondary roads; OR prior to January 1, 2006, were certified as a CAH based on State designation as a “necessary provider” of health care services to residents in the area.
  • Maintain no more than 25 inpatient beds that can be used for either inpatient or swing-bed services;

CAHs are essential in cities such as Decatur and its surrounding communities in Adams County. They provide routine and emergency services that might not very easily be accessible to those living in these areas.

One of the goals of CAHs in general is to reduce the financial vulnerability of these rural hospitals.

A huge part of the success of these hospitals is the dedication of it staff from doctors, nurses, and the executive level all the way to every single department that participates in the successful daily running of such a facility and must include the pre-hospital care. 

While these holiday celebrations are occurring there are troubling trends occurring threatening the survival of these rural hospitals. Staggering data from a report by the Bipartisan Policy Center, of 2,176 rural hospitals, 441 are facing three or more financial challenges that put them at risk of service reduction or closure. Some of these challenges include having negative total operating margins, negative operating margins on patient services alone, negative current net assets and negative total net assets. Over 900 rural hospitals face two or more risk factors, while 173 hospitals face four factors.

One ray of limited optimism is that many rural facilities haven’t closed already because they have been the recipients of a stream of billions of dollars in federal relief funds from the COVID-19 stimulus bill. That funding, unfortunately, is disappearing.


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